SEND ORDER TO:
Burr, Patterson & Auld Co.
P.O. Box 800
Elwood, IN 46036 (800)422-4348

JEWELRY ORDER FORM*

Item and Number

14K

10K

Goldlad or Silver Finish

1. Official Badge with .05 Diamond

Official Badge with .04 Diamond

Official Badge with .03 Diamond

Official Badge with One Zircon

-

$130.50

$68.50

-

118.50

63.50

-

105.50

57.50

-

53.50

28.50

 

2. Official Badge Tie Tac

(Same prices as shown above for Official Badge)

6. Monogram Charm or Tie Tac

40.50

28.50

10.00

  7. Monogram Lapel Button

-

-

10.00

  8.Monogram Tie Tac with Chain

-

-

10.25

9. 3/4" Circle Charm

71.50

52.50

18.50

10.Circle Charm

83.50

61.50

25.50

11. Badge with Zircon mounted on Filigree Charm w/18" GF Chain

-

-

35.50

ENGRAVING: $4.00 per badge for initials, chapter and date. For information on available pin guards, contact the Burr, Patterson, & Auld, Co.

TERMS: Prepaid or Deposit/COD. There is no service charge or minimum order amounts. Orders placed within Indiana are subject to applicable state sales taxes (except for sales tax exempt organizations). MAKE CHECKS PAYABLE TO: BURR, PATTERSON & AULD CO., INC.


Quantity

Item #

Cost Each

Total Cost

Pin Guard

Engraving Information

TOTAL COST OF ITEMS ORDERED: $___________________

ENGRAVING COSTS: $____________________

TAX, IF APPLICABLE $____________________

TOTAL ____________________


SHIP TO:

NAME

ADDRESS (Street, City, State, Zip)

PHONE


*THIS FORM MAY BE DUPLICATED AS NEEDED.

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October 6, 2003